USMLE Blog
Step 2 Sample Test Answers + Explanations 2026
USMLE STEP 2 Free 120 Explanations
Updated May 2026
I hope you enjoy reading this blog post.
If you want our team’s expert help with your USMLE prep, click here
Updated as of May 2026
Here are the detailed explanations of the new Free 120 NBME STEP 2 Sample Test Questions so you don’t waste your time trying to find the correct answers and explanations. We had our expert USMLE tutors who scored 260+ on their exams refine these answers and explanations for you so you can spend your valuable time learning!
You can download the Free 120 STEP 2 Sample Test Questions on the USMLE website here. The order of answers and explanations here is based on the online NBME platform (not the pdf) as of May 2026.
Stop wasting valuable study time trying to memorize low-yield details. Our Free High-Yield USMLE Notes 📚 for Step 1 and Step 2 CK are built for efficient learning, ensuring you master the core concepts necessary to ace both exams—even on a tight schedule.
You can also bundle these notes with our full course, which explains the notes in-depth and covers additional high-yield concepts. Enroll today for USMLE Step 1, Step 2, or Step 3 prep.
Table of Contents
✅ Get Full Access to All 6 Blocks – For FREE!
You’ll find Block 1 answers on this page.
To access the PDF of the answers for Blocks 3, 4, 5 and 6, just sign up here and we’ll send them to your inbox — completely free.
To access the PDF of the answers for Blocks 3, 4, 5 and 6, just sign up here and we’ll send them to your inbox — completely free.
Block 1
Question 1:
The correct answer is F. This patient’s symptoms of numbness, absent deep tendon reflexes, and decreased vibration and proprioception are consistent with peripheral neuropathy, likely due to vitamin B12 deficiency. Chronic calcium carbonate use can impair B12 absorption by reducing gastric acid secretion, which is required to release B12 from food. Vitamin B12 supplementation is necessary to prevent further neurological damage and to restore B12 levels. This is particularly important in elderly patients or those with long-term antacid use.
Incorrect answers:
A. Alcohol cessation: Chronic alcohol use can contribute to neuropathy but typically also causes cerebellar dysfunction, leading to ataxia and an abnormal gait, which are not observed in this patient.
B. Calcium carbonate cessation: Stopping calcium carbonate may reduce B12 depletion, but replenishing B12 stores with supplementation is the more direct treatment.
C. Folic acid supplementation: Folic acid deficiency causes macrocytic anemia but does not typically result in peripheral neuropathy.
D. Niacin supplementation: Niacin deficiency presents as pellagra, characterized by diarrhea, dermatitis, and dementia, not peripheral neuropathy.
E. Vitamin B1 (thiamine) supplementation: Thiamine deficiency results in Wernicke encephalopathy, presenting as confusion, ataxia, and ophthalmoplegia, which are not seen in this case.
Question 2:
The correct answer is D. This child presents with specific difficulties in reading despite having an average IQ and age-appropriate daily living skills, which is characteristic of a learning disorder. Learning disorders affect specific academic skills (e.g., reading, mathematics, or writing) and are not associated with global intellectual impairment. The slow acquisition of English is expected given his recent adoption and prior Russian language background. His receptive language abilities and age-appropriate skills further confirm that this is a specific academic issue rather than a global developmental delay. In adopted children, language acquisition difficulties are common due to exposure to a new language environment, and these must be distinguished from true learning disabilities by assessing their native language proficiency and academic skills.
Incorrect answers:
A. Autism spectrum disorder: This child does not exhibit persistent deficits in social communication or interaction, nor restricted or repetitive patterns of behavior.
B. Fetal alcohol syndrome: The patient lacks the characteristic facial features (e.g., smooth philtrum, thin upper lip), growth restrictions, and CNS abnormalities associated with this condition.
C. Intellectual developmental disorder: The child’s average IQ and age-appropriate adaptive functioning exclude this diagnosis.
E. Post-traumatic stress disorder: Although the child has a traumatic background, there are no symptoms of re-experiencing, avoidance, or hyperarousal to suggest PTSD.
F. Reactive attachment disorder: The child demonstrates healthy emotional attachment and social engagement, which excludes this diagnosis.
✅ Get Full Access to All High-Yield NOTES – For FREE!
To access all the PDFs of the Step 2 CK High-Yield topics, sign up below and we’ll send them to your inbox — completely free.
Question 3:
The correct answer is E. The newborn hemoglobin electrophoresis showing an FS pattern indicates that the infant has sickle cell disease (SCD). The absence of hemoglobin A confirms this diagnosis. SCD predisposes children to life-threatening infections, particularly due to functional asplenia from early splenic infarction. The most appropriate next step is to initiate penicillin prophylaxis to prevent invasive infections, particularly from Streptococcus pneumoniae. Prophylaxis is typically started by 2 months of age and continued until at least age 5.
Incorrect answers:
A. Deferoxamine therapy: Used for iron overload in transfusion-dependent patients, not for routine management of SCD.
B. Hydroxyurea therapy: Increases fetal hemoglobin (HbF) and reduces vaso-occlusive crises but is not started in asymptomatic neonates.
C. Iron supplementation: Not indicated unless there is iron deficiency anemia, which is rare in neonates with SCD.
D. Monthly blood transfusions: Reserved for specific complications of SCD, such as stroke prevention, and is not routine at this stage.
F. Vitamin B12 (cyanocobalamin) supplementation: Not indicated, as there is no evidence of vitamin B12 deficiency.
Question 4:
The correct answer is E. The patient presents with hematemesis, mid-epigastric tenderness, and positive stool occult blood, which are consistent with an upper gastrointestinal (GI) bleed. Esophagogastroduodenoscopy (EGD) is the diagnostic and therapeutic procedure of choice for upper GI bleeding. It allows direct visualization of the esophagus, stomach, and duodenum, enabling identification and treatment of the bleeding source.
Incorrect answers:
A. Abdominal CT scan: Not first-line for GI bleeding; does not provide therapeutic capability.
B. Octreotide scan: Used for detecting ectopic endocrine activity, not for acute GI bleeding.
C. Technetium 99m scan: Used for slow or intermittent GI bleeds, but EGD is the preferred diagnostic tool for acute cases.
D. Colonoscopy: Evaluates the lower GI tract and is irrelevant for hematemesis, which indicates an upper GI source.
F. Mesenteric angiography: Reserved for cases of refractory bleeding when endoscopy is not diagnostic or therapeutic.
Question 5:
The correct answer is D. The patient has an upper GI bleed confirmed by esophagogastroduodenoscopy, and the endoscopic findings likely reveal an actively bleeding lesion or a high-risk lesion for rebleeding, such as a visible vessel or adherent clot. Endoscopic hemostatic therapy, which includes techniques such as injection therapy, thermal coagulation, or application of hemostatic clips, is the most appropriate next step. These interventions control active bleeding and reduce the risk of rebleeding.
Incorrect answers:
A. Octreotide therapy: Used for variceal bleeding associated with portal hypertension, not for non-variceal bleeding.
B. Omeprazole therapy: Proton pump inhibitors are used for peptic ulcer disease to reduce acid production but do not control active bleeding.
C. Tyrosine kinase inhibitor therapy: Indicated for gastrointestinal stromal tumors, not for acute GI bleeding.
E. Endoscopic biopsy: Used for diagnosing suspected lesions but is not the priority in acute bleeding.
F. Endoscopic resection: Appropriate for removing tumors or polyps but not for managing acute bleeding.
Question 6:
The correct answer is C. This elderly woman with advanced dementia, dependent on a single caregiver, presents with multiple unexplained bruises and a distal radial fracture without a clear mechanism of injury. Her unkempt appearance and poor hygiene further suggest possible elder abuse and neglect.
Elder abuse should be considered in vulnerable populations, particularly when there are unexplained injuries, poor hygiene, and signs of neglect. Reporting to adult protective services is a legal and ethical obligation. In suspected elder abuse, mandatory reporting to Adult Protective Services (APS) is the appropriate next step to ensure the patient’s safety and initiate an investigation. Reporting to APC is an ethical obligation, even if you are not 100% sure. APS can assess the living environment and determine if further intervention, such as removal from the home or additional caregiver support, is necessary.
Incorrect answers:
A. Admit the patient to the hospital – Hospitalization provides temporary safety but does not address the underlying risk of ongoing abuse at home.
B & D. Arrange placement/provide phone numbers of nursing care facilities – Long-term placement may be needed, but reporting suspected abuse must occur first before determining next steps.
E. Recommend evaluation at a geriatric clinic – A comprehensive geriatric assessment may be beneficial, but it does not address the immediate safety concerns associated with potential abuse.
Question 7:
The correct answer is D. Spinal stenosis
The patient’s history of back pain radiating into both legs, which is worsened by standing or walking and relieved by sitting or flexing the spine, is characteristic of neurogenic claudication due to lumbar spinal stenosis. The symptoms typically arise from pressure on the spinal nerves in the lumbar region, and degenerative changes with age are a common cause. It’s important to recognize that spinal stenosis pain is positional and worsens with lumbar extension (standing or walking), whereas relief is obtained with lumbar flexion (sitting or leaning forward).
Incorrect answers:
A. Abdominal aortic aneurysm: Typically asymptomatic unless ruptured and would not explain the positional nature of leg pain and tingling seen in this patient.
B. Osteoporosis: While it can cause back pain, osteoporosis would not cause radicular pain or tingling in the legs, and it does not have the positional characteristics of spinal stenosis.
C. Peripheral neuropathy: Causes distal symmetric numbness or pain, typically not associated with positional changes. It also lacks the relief with flexion and worsening with extension seen in spinal stenosis.
E. Vascular claudication: Characterized by leg pain that is relieved by rest, not positional changes like lumbar flexion. Additionally, vascular claudication does not typically cause tingling, and the ankle-brachial index would be abnormal in cases of peripheral arterial disease.
Question 8:
The correct answer is D. This patient with a history of cystic fibrosis most likely has pneumonia, evidenced by fever, cough, crackles, leukocytosis, and consolidation on the chest X-ray. Sputum culture is the next step to narrow the spectrum of antibiotics and perform sensitivity testing. The most common organisms colonizing the bronchial tree in cystic fibrosis are Staphylococcus aureus in children and Pseudomonas aeruginosa in adults.
Incorrect answers:
A. CT angiography is used for suspected pulmonary embolism (PE). Chest X-ray is typically normal in PE. The presence of leukocytosis, cough, and consolidation supports another diagnosis.
B. Serum immunoglobulin testing is used to diagnose patients with recurrent infections. This patient already has a history of cystic fibrosis complicated by bronchiectasis.
C. Spirometry is used to diagnose obstructive and restrictive lung diseases. The patient’s main presentation is infectious in etiology, so this test may be done later to assess pulmonary function.
E. Transbronchial biopsy is an invasive procedure typically used to diagnose lung cancers or abnormal masses on imaging.
Question 9:
The correct answer is A. This patient on warfarin therapy has an elevated PT/INR, likely due to the recent addition of TMP/SMX, which inhibits the CYP450 system, warfarin metabolism is decreased, resulting in an increased plasma concentration. Other medications that inhibit the P450 system include: Cimetidine, Ciprofloxacin, Omeprazole, Metronidazole, Erythromycin, protease inhibitor, grapefruit (COKE,PIE and grapefruit)
Incorrect answers:
B. Certain vitamin K-rich foods (e.g., spinach) can decrease INR, not increase it.
C. Echocardiography is used to assess structural heart disease but is not relevant here.
D. Venous duplex ultrasound is indicated for suspected deep vein thrombosis (e.g., unilateral leg swelling, edema), which is not the case here.
E. Allopurinol does not have a significant interaction with warfarin.
Question 10:
The correct answer is D. This neonate with myelomeningocele and loss of movement in the lower extremities likely has significant spinal cord injury in the lumbosacral region. Neurogenic bladder dysfunction is common due to pelvic nerve involvement. The lower extremity and bladder are innervated by the same spinal and cortical regions, which is why dysfunction in these areas often occurs together.
Incorrect answers:
A. Congenital heart malformations can occur in isolation or as part of syndromes such as velocardiofacial syndrome. However, they are not directly linked to myelomeningocele.
B. Cryptorchidism is more commonly associated with prematurity or testosterone deficiency rather than neural tube defects.
C. Spina bifida is often due to inadequate maternal folate intake, but it is not directly associated with impaired folate metabolism.
E. Although mild ventriculomegaly is present, it does not necessarily indicate severe cognitive impairment.
Question 11:
The correct answer is B. This patient presents with symptoms of hyperglycemia (polyuria, polydipsia, weight loss), a blood glucose level of 578 mg/dL, and an elevated hemoglobin A1c of 10.7%, consistent with diabetes mellitus. The rapid onset of symptoms, significant weight loss, and low BMI strongly suggest type 1 diabetes mellitus (T1DM) rather than type 2 diabetes mellitus. In T1DM, there is an absolute deficiency of insulin due to autoimmune destruction of pancreatic beta cells. Insulin therapy is required to manage hyperglycemia and prevent diabetic ketoacidosis.
Incorrect answers:
A. Glyburide therapy: Sulfonylureas stimulate insulin secretion from functional beta cells, which are absent in T1DM.
C. Metformin therapy: Primarily used for type 2 diabetes to reduce hepatic glucose production; ineffective in T1DM.
D. Pioglitazone therapy: A thiazolidinedione that improves insulin sensitivity; not suitable for T1DM as it does not address the lack of insulin.
E. Sitagliptin therapy: A DPP-4 inhibitor used for type 2 diabetes to enhance incretin activity; ineffective in T1DM.
Question 12:
The correct answer is B. This patient presents with a persistent, nonproductive cough following an upper respiratory tract infection, accompanied by post-tussive vomiting and bursts of coughing, which are characteristic of pertussis (whooping cough). Bordetella pertussis, the causative organism, is treated with a macrolide antibiotic such as azithromycin. Early treatment reduces bacterial transmission, although it may not significantly alter the course of symptoms once the paroxysmal stage has begun.
Incorrect answers:
A. Albuterol: Used for bronchospasm in asthma or COPD, which this patient does not have.
C. Levofloxacin: A fluoroquinolone used for severe or complicated bacterial infections but not indicated for pertussis.
D. Omeprazole: A proton pump inhibitor for GERD, unrelated to this patient’s symptoms.
E. Prednisone: An anti-inflammatory for asthma, COPD exacerbations, or autoimmune diseases, none of which are present here.
Become a Researcher in the United States 
No Experience Required! Just join the live & interactive workshop to learn all the secrets of landing a research position in the U.S
Question 13:
The correct answer is D. Pericardiocentesis
The patient presents with signs of cardiac tamponade following a penetrating chest wound. The hallmark signs of tamponade, often referred to as Beck’s triad (hypotension, muffled heart sounds, and jugular venous distention), are present due to blood accumulating in the pericardial sac, which increases pressure and impedes cardiac filling. This leads to decreased cardiac output. Pericardiocentesis is the treatment to relieve pressure and stabilize the patient. focused assessment with sonography for trauma (FAST) is helpful in confirming the presence of pericardial fluid in trauma cases.
Incorrect answers:
A. CT scan of the chest and abdomen: Not the immediate choice in an unstable trauma patient. Pericardiocentesis is prioritized to stabilize the patient before imaging.
B. Exploratory laparotomy: This would be indicated for abdominal injuries, but the symptoms suggest cardiac tamponade, not abdominal trauma.
C. Needle decompression and chest tube placement: This is used for tension pneumothorax, which presents differently, with respiratory distress and absent breath sounds, not the cardiac symptoms seen here.
E. Peritoneal lavage: An older method for detecting intra-abdominal injury, now replaced by FAST. In this case, the problem is cardiac, not abdominal.
Question 14:
The correct answer is C. Coronary artery disease
The patient’s long-standing type 1 diabetes mellitus and ST-segment depression on the exercise stress test indicate myocardial ischemia, pointing to coronary artery disease (CAD). Diabetes, especially when uncontrolled over many years, significantly increases the risk of atherosclerosis and CAD. The ST-segment depression suggests ischemia, making CAD the most likely diagnosis. In a diabetic patient, even in the absence of chest pain (due to potential diabetic neuropathy causing silent myocardial ischemia), significant ST-segment changes on a stress test strongly point towards CAD.
Incorrect answers:
A. Cardiomyopathy: No signs of heart failure are present, and the murmur doesn’t fit the typical pattern of cardiomyopathy.
B. Congenital heart disease: The murmur and the patient’s age make this diagnosis unlikely.
D. Valvular heart disease: While murmurs are common, valvular heart disease wouldn’t explain the ST-segment changes seen in the stress test.
E. Normal cardiac findings: The ST-segment depression is abnormal and suggests ischemia, not a normal finding.
Are you an IMG trying to find USCE with no luck?
Check the list of our experienced doctors offering USCE to IMGs!
Question 15:
The correct answer is A. Agoraphobia
This patient is experiencing panic attacks, characterized by sudden onset of intense fear and somatic symptoms like rapid heartbeat, sweating, and nausea. The patient also describes avoiding situations due to the fear of having another attack, which is a hallmark of agoraphobia. For USMLE/NBME, understanding that agoraphobia arises when patients avoid places or situations where they might have a panic attack is key.
Incorrect answers:
B. Generalized anxiety disorder: This disorder involves chronic, excessive worry about multiple aspects of life, rather than specific, situational panic attacks.
C. Illness anxiety disorder: The patient is not excessively worried about having a serious illness but rather about the occurrence of panic attacks.
D. Social anxiety disorder: The fear here is of social situations where one might be scrutinized by others, not fear of panic attacks in specific situations.
E. Somatic symptom disorder: This condition involves physical symptoms causing distress, but it is not linked to the intense fear and avoidance behavior seen in agoraphobia.
Question 16:
The correct answer is C. X-rays of the left hand and wrist
The girl’s short stature and delayed puberty point to a possible delay in skeletal maturation. X-rays of the left hand and wrist, known as a bone age study, are used to assess skeletal maturity and help determine future growth potential. A delayed bone age compared to chronological age suggests that the patient may have constitutional growth delay, which is a normal variant where growth is delayed but ultimately follows a typical growth trajectory once puberty begins.
Incorrect answers:
A. Complete blood count and serum chemistry panel: These tests would be more helpful if there were signs of anemia, infection, or metabolic disturbances. However, they are not the first step in assessing growth delay without other concerning symptoms.
B. Measurement of urine-free cortisol concentration: This test is relevant in evaluating Cushing’s syndrome, but there is no evidence in the history or physical exam to suggest this diagnosis.
D. X-rays of the long bones and spine: These are more useful for evaluating skeletal dysplasias or bony pathologies, but in this case, the focus is on assessing the girl’s growth potential, which is best done with a bone age study.
E. X-ray of the skull: This would be relevant if there were concerns about cranial abnormalities (e.g., craniosynostosis), but there is no indication of such a problem here.
Question 17:
The correct answer is D. Ultrasonography of the bladder
The patient’s drop in urine output after surgery, combined with bilateral pubic rami fractures, raises concern for a bladder injury or post-renal acute kidney injury (AKI). Ultrasonography of the bladder is the most appropriate next step, as it can quickly detect bladder distension, rupture, or other issues like blood in the bladder, which are common after pelvic fractures. This non-invasive method helps rule out bladder injury as a cause of the patient’s symptoms.
Incorrect answers:
A. CT scan of the abdomen and pelvis: While useful for trauma, it’s not the first step in evaluating the bladder for injury, especially when ultrasonography can provide a faster, more specific answer for bladder-related issues.
B. Repeat surgical exploration of the abdomen: There are no clear signs suggesting an abdominal catastrophe (such as ongoing bleeding or perforation), so repeating the surgery isn’t justified at this point.
C. Transfusion of packed red blood cells: Though the patient has bloody urine, there’s no evidence of active hemorrhage or significant blood loss to warrant immediate transfusion. The issue here is more likely related to urinary retention or injury, not ongoing blood loss.
Question 18:
The correct answer is E. This patient has a bicornuate uterus, a congenital anomaly that can be associated with other congenital conditions, such as having a single kidney (as in this case). A single kidney typically doesn’t pose significant risks during pregnancy. Abnormality in the structure of uterus (e.g. cornuate uterus, fibroids) raises the risk of preterm labor.
Incorrect answers:
A. Fetal macrosomia: Fetal macrosomia is generally associated with diabetes and obesity
B. Multiple gestation: Multiple gestation is more likely due to genetic predisposition or medication use (e.g., clomiphene).
C. Oligohydramnios: A single kidney is unlikely to cause oligohydramnios, which is typically related to fetal renal issues.
D. Preeclampsia: A single kidney is not associated with an increased risk of preeclampsia.
Unlock your research potential with our dynamic course designed for medical students and graduates! Built by an experienced clinical researcher with 150+ publications and 3000+ citations!
Question 19:
The correct answer is D. Bacterial vaginosis (BV) is indicated by the patient’s white-gray discharge and elevated vaginal pH (normal is 3.8-4.5). BV is a known risk factor for postoperative infections after gynecologic procedures. BV is NOT sexually transmitted but it’s associated with sexual activity. No need to treat the male partner, unlike Trichomonas vaginalis infection.
Incorrect answers:
A. History of upper respiratory tract infection: This is not directly linked to pelvic infections or postoperative complications.
B. HSV 2: While HSV 2 can cause complications in the presence of active lesions, this patient has no active lesions, so it is not the strongest risk factor here.
C. Obesity: Obesity can lead to worsened postoperative outcomes, but it is not the primary concern in this context.
E. Vulvar shaving: Shaving can introduce minor skin irritation or tears, but it is not as significant a risk factor for infection as BV.
Question 20:
The correct answer is E. The patient has declining mental status and likely lacks the capacity to make medical decisions. In the absence of durable power of attorney, the next of kin is responsible for making medical decisions. In this case, the son is the next of kin. Next-of-kin decision makers are: 1) advance directive, 2) Spouse, 3) adult children, 4) parents, 5) adult siblings
Incorrect answers:
A. Boyfriend: Without legal marriage or a designated healthcare proxy, the boyfriend is not considered the next of kin.
B. Neighbor: While the neighbor is a trusted individual, she is not a family member and is at the lowest level of the decision-making hierarchy.
C. Patient: The patient’s declining mental status makes it ethically inappropriate for her to make medical decisions.
D. Physician: The physician cannot make medical decisions, except in emergency situations when no family members are available or when a substituted decision is necessary.
Block 2
Question 21:
The correct answer is A. Audiography
The child’s recurrent fractures with minimal trauma and bluish sclera strongly suggest Osteogenesis Imperfecta (OI), a collagen synthesis disorder that causes fragile bones. One common complication of OI is sensorineural hearing loss, which can occur in early childhood or adolescence. Audiography is recommended as part of routine care for children with OI to detect hearing loss early and manage it effectively.
Incorrect answers:
B. DEXA scan: Although OI affects bone strength, DEXA is more useful for diagnosing osteoporosis in adults, especially postmenopausal women, not for diagnosing OI.
C. Echocardiography: OI typically does not involve significant heart abnormalities, so echocardiography is unnecessary unless there are specific cardiovascular symptoms.
D. Retinal examination: There are no primary retinal manifestations of OI, so this exam is not indicated in this case.
E. Serum calcium and vitamin D: While useful for diagnosing metabolic bone diseases or vitamin D deficiency, these tests are not directly related to diagnosing or managing OI.
Need Help Strengthening Your Research Experience?
Residency programs love applicants with strong research experience! Learn how to publish research, get involved in projects, and impress program directors with our comprehensive clinical research course.
Question 22:
The correct answer is A. Female factor infertility. The patient’s history of pelvic inflammatory disease (PID) suggests that tubal scarring is a likely cause of her infertility. PID, particularly when untreated or recurrent, can lead to damage to the fallopian tubes, resulting in tubal obstruction or adhesions, which can prevent fertilization. Hysterosalpingography in this case shows absence of contrast in fallopian tubes.
Incorrect answers:
B. Hydatidiform mole: There’s no indication in this case that the patient is at risk for a molar pregnancy. Hydatidiform mole is typically associated with abnormal pregnancies, not infertility in the way described here.
C. Recurrent spontaneous abortions: While PID can increase the risk of ectopic pregnancy, it doesn’t directly cause recurrent spontaneous abortions. This patient’s issue is primarily infertility, likely due to tubal factors, not repeated miscarriages.
D. Successful pregnancy within the next year: Given the patient’s likely tubal damage from PID, the probability of a spontaneous, successful pregnancy is reduced without intervention. A thorough evaluation and potential treatment (e.g., in vitro fertilization) would likely be necessary.
Question 23:
The correct answer is B. Surgical biopsy of the oral lesion
The patient’s history of long-term chewing tobacco use and the presence of a chronic white lesion on the buccal mucosa suggest leukoplakia, a premalignant lesion. Leukoplakia cannot be scraped off and is associated with an increased risk of dysplasia or carcinoma. A surgical biopsy is the definitive diagnostic step to evaluate for malignancy or dysplasia in such lesions. Smokeless tobacco significantly raises the risk of oral cancers and should always prompt evaluation of suspicious oral findings.
Incorrect answers:
A. Prescribing oral nystatin suspension: Oral nystatin treats oral candidiasis, which presents with white plaques that can be scraped off and typically occurs in immunosuppressed individuals, which is not the case here.
C. Swabbing the lesion for cytology: Cytology is less definitive than a biopsy for detecting dysplasia or carcinoma, especially for suspicious lesions in high-risk individuals.
D. Observation only: Given the patient’s tobacco use and the lesion’s premalignant potential, observation without further evaluation is inappropriate and risky.
Question 24:
The correct answer is C. Small vessel disease
The patient’s sudden onset of left-sided weakness, mild headache, and CT findings consistent with an ischemic stroke in the right putamen are indicative of a lacunar infarct, commonly caused by small vessel disease. Hypertension, a key risk factor, leads to pathological changes in small penetrating arteries, including lipohyalinosis and eventual vessel occlusion. These changes often affect deep brain structures like the basal ganglia, thalamus, and internal capsule. Lacunar infarcts typically result in pure motor or sensory deficits, as seen here.
Incorrect answers:
A. Amyloid angiopathy: Typically causes lobar hemorrhages, especially in elderly patients, rather than ischemic strokes in the basal ganglia.
B. Embolism: Often leads to cortical infarcts with associated cortical signs (e.g., aphasia, neglect), which are absent in this case.
D. Vasculitis: Can cause ischemic strokes but is rare and usually presents with systemic symptoms like fever or multi-organ involvement, which are not present here.
E. Venous thrombosis: More commonly presents with diffuse symptoms like headache, papilledema, or seizures rather than a focal basal ganglia lesion.
Question 25:
The correct answer is C. This patient with colon cancer has a history of bowel obstruction and prior bypass surgery. Given that he is not a candidate for further surgical intervention, another operation would not be beneficial and could lead to complications. The best approach is to clearly explain the risks and futility of surgery to the patient and his family.
Incorrect answers:
A. While patient autonomy is important, Nonmaleficence sometimes takes precedence when an intervention is unlikely to provide benefit and may cause harm.
B. Altering chemotherapy is unlikely to resolve the current obstruction.
D. Transferring the patient to another facility would not change the prognosis or treatment options.
E. External beam radiation is more beneficial for localized metastatic prostate cancer to the spine, not for diffuse peritoneal carcinomatosis.
Question 26:
The correct answer is C. This patient presents with chronic malaise, fatigue, cough, low-grade fever (37.7°C), and a reticulonodular pattern on chest X-ray, which is characteristic of hypersensitivity pneumonitis (HP). HP is often caused by exposure to environmental antigens, such as wood dust in this scenario. Treatment is usually avoidance and elimination of antigen, corticosteroid for acute symptoms. Chronic disease requires immunosuppressive therapy.
Incorrect answers:
A. Aspergillosis: Aspergillus can cause aspergilloma, which appears as a round mass on chest X-ray, or allergic bronchopulmonary aspergillosis, but the reticulonodular pattern makes aspergillosis less likely.
B. Asthma recurrence: Asthma exacerbations are usually associated with an obstructive pattern on pulmonary function tests, while this patient shows a mixed obstructive and restrictive pattern. Additionally, chest X-ray would show hyperinflation, not a reticulonodular pattern.
D. Sarcoidosis: Sarcoidosis is more common in middle-aged African American women and typically presents with interstitial infiltrates and hilar lymphadenopathy
E. Silicosis: Silicosis is common in workers exposed to silica dust, and while it typically affects the upper lung fields, it would also show characteristic hilar lymph node calcifications (egg shell calcifications).
Don’t let subpar interview performance prevent you from matching. Ace your residency interviews with our experts’ advice! Each session is half real-time mock interview and half as feedback.
Question 27:
The correct answer is E. This adolescent, who has recently started socializing with new peers and engaging in minor rule-breaking behavior, is likely exhibiting normal development. At this age, adolescents naturally seek independence and privacy while forming stronger peer relationships. For psychiatry questions, if a patient develops behaviors that are not extreme and do not cause significant occupational or social problems, they are typically considered within the range of normal behavior.
Incorrect answers:
A. Adjustment disorder occurs in response to an identifiable stressor and causes significant distress or impairment, which is not evident in this case.
B. ADHD is characterized by attention deficits and hyperactivity in multiple settings (e.g., home and school), typically present from early childhood.
C. Conduct disorder involves stealing, physical aggression, and violating others’ rights, which are not observed in this patient.
D. Oppositional defiant disorder is characterized by vindictiveness and defiant behavior without physical aggression or severe rule-breaking.
Question 28:
The correct answer is A. Conducting weekly structured team briefings and daily huddles is the most effective method for maintaining a common mental model and ensuring clear communication within the team. Regular meetings provide an opportunity to share updates on patients and adjust care plans as needed, fostering a shared understanding of patient status and goals. For safety and quality questions, it’s important to focus on measures that are efficient and resource-effective, avoiding time-consuming processes or financial compensations (such as paying doctors and nurses) that could lead to wasted resources.
Incorrect answers:
B. Educating team members on protocols for common illnesses is important for clinical practice but does not directly improve communication within the team or ensure a shared understanding of individual patient cases.
C. Discussing the case with each team member individually may lead to miscommunication and lack of cohesion, rather than promoting effective team communication.
D. While maintaining a consistent team of intensivists can improve continuity of care, it does not specifically address communication between team members.
E. A disease-specific ICU may improve care for particular conditions but does not inherently enhance communication among the broader team caring for complex patients.
Question 29:
The correct answer is B. This patient with Parkinson’s disease is experiencing postural instability, evidenced by frequent falls, backward falls when walking, and failure to maintain posture during a pull test. Physical therapy, particularly focusing on balance training and gait exercises, is the most effective intervention to reduce the risk of future falls. Physical therapy improves strength, stability, and movement coordination, which are critical for addressing postural instability in Parkinson’s disease.
Incorrect answers:
A. Biofeedback: may be used for somatic symptom disorder, no consistent evidence supports its effectiveness in managing postural instability related to Parkinson’s disease.
C. Pramipexole therapy, D. Ropinirole therapy, E. Rotigotine therapy: dopamine agonists used for Parkinson’s symptoms of rigidity and bradykinesia but do not address postural instability or fall prevention.
Crush the Biostatistics of USMLE STEP 1, STEP 2 CK, and STEP 3 exams
Question 30:
The correct answer is D. This patient presents with episodic headaches, palpitations, sweating, and hypertension, along with a 4-cm adrenal mass on CT imaging. These findings strongly suggest pheochromocytoma, a catecholamine-secreting adrenal tumor. The first step in confirming this diagnosis is measuring plasma free metanephrines or 24-hour urine fractionated metanephrines and catecholamines. Elevated levels confirm the biochemical diagnosis, guiding further management.
Incorrect answers:
A. 24-Hour urine collection for measurement of vanillylmandelic acid and 5-hydroxyindoleacetic acid: Used to diagnose neuroblastoma (vanillylmandelic acid) or carcinoid syndrome (5-hydroxyindoleacetic acid), not pheochromocytoma.
B. Adrenal venous sampling: Reserved for differentiating primary hyperaldosteronism causes, such as adrenal adenoma versus bilateral adrenal hyperplasia.
C. Laparoscopic left adrenalectomy and right adrenal biopsy: Surgery is premature without biochemical confirmation of pheochromocytoma, as it requires specific preoperative management to prevent hypertensive crises.
E. Transsphenoidal hypophysectomy: Relevant for pituitary tumors, not adrenal lesions.
Question 31:
The correct answer is A. This randomized controlled trial (RCT) found that the new antiarrhythmic drug reduced recurrent episodes of ventricular tachycardia, but the investigators incorrectly concluded that it decreases mortality from cardiac arrhythmia.
This is an example of extrapolation beyond data—the study did not assess mortality as an outcome, so making claims about mortality reduction is scientifically invalid. When interpreting study results, it is crucial to distinguish between statistical significance and clinical relevance, avoiding unwarranted extrapolation of findings to outcomes not directly measured, such as mortality.
Incorrect answers:
B. Insufficient power – The study found a statistically significant difference (p < 0.05), meaning it had sufficient power to detect an effect.
C. No information regarding confidence interval – While confidence intervals provide additional precision, the main flaw here is the overgeneralization of results, not a lack of interval reporting.
D. Selection bias – There is no mention of inappropriate participant selection or non-randomized allocation, making selection bias unlikely.
Question 32:
The correct answer is B. This patient presents with 3 months of postprandial epigastric pain without alarming features (e.g., weight loss, anemia, vomiting), which suggests peptic ulcer disease (PUD) or gastritis.
Endoscopy is the gold standard for diagnosing PUD and gastritis, allowing for direct visualization and biopsy to confirm the diagnosis and rule out H. pylori infection or malignancy.
Incorrect answers:
A. CT scan of the abdomen – More useful for detecting structural abnormalities (e.g., tumors, pancreatitis), not mucosal lesions like ulcers.
C. Examination of the stool for ova and parasites – Indicated for parasitic infections (e.g., Giardia, Entamoeba histolytica), which typically cause diarrhea and weight loss, not isolated epigastric pain.
D. Stool culture – Used for bacterial gastroenteritis (e.g., Salmonella, Shigella, Campylobacter), which presents with fever and diarrhea, not chronic postprandial pain.
E. Upper gastrointestinal series – Can detect ulcers, but is less sensitive than endoscopy and does not allow for biopsy or H. pylori testing.
Feeling swamped by the complexities of Systematic Reviews? Kickstart your research journey with our comprehensive Systematic Review Course and build your skills with confidence!
Question 33:
The correct answer is B. This patient presents with sudden onset of flank/lumbar pain, gross hematuria, and unilateral hydronephrosis with hydroureter, strongly suggesting a ureteral stone. Non-contrast CT of the abdomen and pelvis is the gold standard for diagnosing ureteral stones. It provides a detailed view of the renal tract, identifying stones and their exact location, as well as any complications like obstruction.
Incorrect answers:
A. Captopril renography: Typically used for diagnosing renovascular hypertension due to renal artery stenosis, which is unrelated to this patient’s acute presentation.
C. MAG-3 renal scan with furosemide: Utilized to distinguish obstructive from non-obstructive hydronephrosis but is not indicated as the first-line test in acute obstruction suspected due to ureteral stone.
D. Radionuclide cystography & E. Retrograde pyelography: These are used for assessing vesicoureteral reflux and other structural abnormalities. They are not first-line for evaluating suspected stones.
F. Ultrasonography of the spinal column: Indicated for spinal dysraphism, often identified by external markers such as a tuft of hair or dimple in the lower back, which are absent in this case.
G. Voiding cystourethrography: Performed to assess vesicoureteral reflux, which commonly presents with recurrent urinary tract infections, not acute flank pain and hematuria “HY”.
Question 34:
The correct answer is E. Mirtazapine
Mirtazapine is an atypical antidepressant that effectively treats depression and is particularly useful in patients with insomnia due to its sedative properties. For patients with epilepsy, it is also a safer option because it does not lower the seizure threshold, unlike some other antidepressants. In this case, the patient’s symptoms of depressed mood, fatigue, insomnia, and decreased interest are consistent with major depressive disorder, and mirtazapine is a well-suited option given the coexisting sleep disturbances and epilepsy.
Incorrect answers:
A. Alprazolam: A benzodiazepine used primarily for anxiety disorders, not depression, and carries a risk of dependence.
B. Aripiprazole: An antipsychotic used as an adjunct in treatment-resistant depression, but not a first-line option for this patient’s presentation.
C. Bupropion: While effective for depression, it is activating and lowers the seizure threshold, making it unsuitable for patients with epilepsy.
D. Buspirone: Used for generalized anxiety disorder, it is not an antidepressant and would not address this patient’s depressive symptoms.
Question 35:
The correct answer is C. Fasting glucose tolerance test
The patient’s history of delivering large-for-gestational-age infants, her obesity (BMI of 38 kg/m²), and a family history of type 2 diabetes place her at increased risk for gestational diabetes mellitus (GDM). In such cases, GDM should be screened at the first prenatal visit. The screening usually involves an initial glucose challenge, followed by a more definitive glucose tolerance test if the challenge test is abnormal. For USMLE/NBME, recognize that early screening is essential for high-risk patients like this one.
Incorrect answers:
A. Antiphospholipid antibody screening: This test is typically performed when there is a history of recurrent miscarriages or stillbirths, but it is not indicated based solely on this patient’s history of large babies.
C. Chest x-ray: There is no indication of a respiratory or thoracic issue in this patient, so this test is unnecessary.
D. Measurement of serum α-fetoprotein: This is used for neural tube defect screening, typically between 15-20 weeks’ gestation, not as a general screening in this case.
E. Measurement of serum-free thyroxine: This test would be relevant if there were concerns about thyroid dysfunction, but no such clinical evidence is presented here.
Ace Your Step 2 CK with Expert Guidance
Struggling with Step 2 CK preparation? Get personalized 1-on-1 coaching from top scorers and experienced mentors.
Question 36:
The correct answer is B. This patient, with a medical history of hemophilia A and symptoms of joint pain and swelling, most likely has hemarthrosis (bleeding into the joint). It’s associated with factor VIII deficiency. The primary treatment for hemophilia A is factor VIII replacement therapy. Hemophilia causes deep bleeding (e.g., hemarthrosis), while Von Willebrand disease leads to superficial bleeding (e.g., epistaxis, mucosal bleeding).
Incorrect answers:
A. ADH (Vasopressin) – Used in mild hemophilia A and Von Willebrand disease (VWD) to increase factor VIII and vWF levels, but it is insufficient for moderate to severe hemophilia A or active bleeding.
C. Factor IX concentrate – Used for hemophilia B, which is caused by factor IX deficiency, not hemophilia A.
D. Ferrous sulfate – Used to treat iron deficiency anemia.
E. Fresh frozen plasma (FFP) – Contains clotting factors but is not the first-line treatment for hemophilia A, as it provides less concentrated factor VIII compared to factor VIII concentrate, it’s usually used for rapid reversal of warfarin overdose.
Question 37:
The correct answer is E. This child is undergoing a dental procedure and has no risk factors that would warrant antibiotic prophylaxis for bacterial endocarditis. A heart murmur alone is not considered high risk for prophylaxis. For USMLE, Systolic murmur in young asymptomatic people are usually innocent murmur, no further investigation or management should be done. Diastolic murmur is always pathologic
Incorrect answers:
A. Azithromycin: Typically prescribed for community-acquired pneumonia, not for endocarditis prophylaxis in this scenario.
B. Cephalexin: An alternative to amoxicillin for mild allergic reactions, but unnecessary in this case.
C & D. Clindamycin and Vancomycin: Alternatives to amoxicillin for severe allergic reactions, but not required here due to the lack of high-risk factors.
Question 38:
The correct answer is B. This patient most likely has Lyme disease, evidenced by Bell’s palsy (unilateral facial weakness) and meningitis symptoms (neck flexion induces pain, lymphocytic predominance on lumbar puncture). The second stage of Lyme disease can cause facial nerve palsy. Lumbar puncture in Lyme is similar to viral infection. Also in Lyme arthritis, there’s lymphocytic predominance, WBCs count is around 20,000.
Incorrect answers:
A. Measurement of ACE activity could be associated with sarcoidosis. The common presentation is a middle-aged African American woman with chronic cough and hilar adenopathy on chest X-ray.
C. CMV can cause mononucleosis-like symptoms, including fever, fatigue, and tonsillar exudates.
D. Serum antinuclear antibody is used in suspected rheumatologic conditions like SLE; the absence of malar rash and joint pain makes it less likely.
E. Serum protein electrophoresis is used in the diagnosis of multiple myeloma, which is characterized by hypercalcemia, bone pain, kidney injury, and anemia.
Question 39:
The correct answer is C. Diverticulosis. The patient’s painless, bright red rectal bleeding, especially in the absence of other significant gastrointestinal symptoms, is consistent with diverticulosis. The use of NSAIDs, which can increase the risk of diverticular bleeding, is common in elderly patients. Management include increasing fibers intake, hydration, avoid red meat.
Incorrect answers:
A. Anal fissures are typically associated with tearing pain, often during bowel movements, and not painless rectal bleeding. They are also more common in patients with chronic constipation.
B. Although colonic polyps can cause rectal bleeding, this patient had a colonoscopy 8 years ago with normal findings, making it less likely.
D. Duodenal ulcers typically cause melena (dark, tarry stools) due to upper gastrointestinal bleeding, not fresh, bright red blood.
E. Gastritis generally presents with symptoms like epigastric pain or discomfort and results in melena or coffee-ground emesis, not fresh red blood in the stool.
F. Ulcerative colitis typically affects younger patients and presents with bloody diarrhea and other inflammatory symptoms (fever, abdominal pain), which are not seen in this case.
Question 40:
The correct answer is C. This child with a recent ventricular septal defect (VSD) repair has developed decompensated heart failure, evidenced by cool, clammy skin, cold distal extremities, delayed capillary refill, and minimal urine output (suggesting decreased perfusion). Echocardiography is the most appropriate next step as it is noninvasive and readily available.
Incorrect answers:
A. This is an invasive procedure and is not recommended for the evaluation of decompensated heart failure.
B. It carries risks such as radiation exposure and contrast-induced nephrotoxicity, making it less ideal for this situation.
D. Electrophysiology study: It is used to diagnose arrhythmias, but the patient’s ECG shows no significant findings.
E. MRI of the heart: This is time-consuming, requires sedation, and is not the best first-line evaluation for decompensated heart failure.
Boost your USMLE scores with personalized, one-on-one tutoring from our expert tutors at The Match Guy!
Disclaimer: We did our absolute best to make sure everything is accurate and double checked everything but as with anything done by a human there is still potential for mistakes so if you find anything, please let us know by emailing us at info@thematchguy.com
Block 3, 4, 5 and 6
To access the answers & explanations of the 3rd, 4th, 5th & 6th blocks of the Step 2 sample test questions, please sign-up below for free and we will deliver the full PDF directly to your email inbox!
For personalized Step 2 preparation strategies, high-yield resources, and expert tutoring, explore our Proven USMLE Tutoring packages here.
Free high-yield notes for USMLE Step 1, Step 2, and Step 3, covering essential must-know concepts
You can also bundle these notes with our full course, which explains the notes in-depth and covers additional high-yield concepts. Enroll today for USMLE Step 1, Step 2, or Step 3 prep.
If you need guidance on your target USMLE scores or have questions on improving your chances of matching into your dream specialty, feel free to schedule a call here or text us on WhatsApp here for personalized support.
🍀 We wish you best of luck on your exam!
Latest Articles
ERAS Application 2027 Guide! How to Fill Out ERAS Residency Application?
Malke Asaad July 13, 2023
Best Resources for USMLE STEP 1! How to Study and Prepare for STEP1?
Malke Asaad August 12, 2022
2026 Residency Personal Statement The Ultimate Guide to Crafting Your Residency Personal Statement
Malke Asaad July 8, 2024
Need Help?
About TheMatchGuy
The Match Guy is a premier medical consulting firm trusted by over 35,000 students worldwide. We help medical students and graduates excel on the USMLE (Step 1, Step 2 CK, and Step 3) and strengthen their residency applications through proven study strategies, expert tutoring, and personalized guidance from elite 260+ scoring tutors who have helped countless students achieve their goals. Whether you’re aiming for a competitive specialty or navigating the Match as an IMG, we help you prepare smarter, avoid burnout, and position yourself as a strong applicant from exam day through Match season. Schedule a FREE discovery call now.
RECOMMENDED ARTICLES
Best Electives in the US
Best Resources for USMLE STEP 2 Ck!
United States Clinical Experience for IMGs
